A case of extroversion of the bladder treated by preliminary narrowing of the gap existing in the pubic symphysis by means of division of the sacro-iliac synchondroses / by G.H. Makins.

  • Makins, George Henry, 1853-1933.
Date:
1888
Catalogue details

Licence: Public Domain Mark

Credit: A case of extroversion of the bladder treated by preliminary narrowing of the gap existing in the pubic symphysis by means of division of the sacro-iliac synchondroses / by G.H. Makins. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    at a later date sliould the first flap do well. The opera- tion unfortunately proved a failure, for on the sixth day the centre of the flap sloughed through. The resulting granulating surface quickly healed, leaving a cicatrix, which has proved the principal difficulty in all subsequent procedures. The child left the hospital in August, 1883, and was not seen again until his readmission on November 2nd, 1886, when he was brought to the hospital by his mother on account of some slight haemorrhage occurring from the bladder surface. The condition differed little from that existing in 1883, the only changes consisting in the greater size of the child, and the presence of a firm white cicatrix about one inch in leng’th, which extended outward from the margin of the bladder on the left side, and was closely united to the subjacent aponeurosis of the external oblique. The scrotum was inflamed and red, and on its surface, as well as on the neighbouring skin of the thighs, were numerous ulcerated spots with raised margins, en- crusted with phosphates, somewhat resembling mucous tubercles. The exposed bladder surface now measured three and a quarter inches in each direction. The patient was kept in bed twenty-seven days, and during this time the surrounding skin was got into a much better con- dition, and the bladder surface much improved by the application of pine-wood bags to absorb the urine as it passed. On November 29th, 1886, the following operation was performed :—The bowels having been thoroughly cleared out during the previous day the patient was anaesthetised with chloroform. The space between the anterior superior spines of the ilia was measured, and found to be seven inches, that between the gaping symphysis one and a quarter inches, and the position of the great sciatic notch was determined by rectal examination. The boy was placed on his face, and incisions three inches in length were made over each synchondrosis. The posterior sacro-iliac ligaments were exposed and freely divided, VOL. lxxi. 13